PROSTATE CANCER DIAGNOSIS AND
TREATMENT SELECTION GUIDE
(Updated December 2013 for the USMA Class of 1958)
The first thing you need to do is to get educated on what this disease is all about and what you can do about it so you are better able to play a proactive role in the selection and conduct of your treatment. The "Bible" on the subject is Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer" Third Edition. It's out in paperback. Get a copy and read all about it so you can ask all the right questions and make the best decisions.
Another very helpful source is "Prostate Cancer Breakthroughs" by Jay S. Cohen, M.D., a cancer survivor himself. It provides a step-by-step guide to the most recent cutting edge diagnostic tests to assist you in more effectively assessing the status of your cancer to best enable you to select the right treatment and avoid overtreatment with the accompanying side effects. It includes insights into eight medically proven treatments.
There are also many excellent web sites out there covering various aspects. Go to our own site's "Links to Other Sources" at <http://www.west-point.org/class/usma1958-pc/pc_linksNew.htm> where you will find many links to various subjects, from general to very specific. Here are a few good ones to get you started:
Get the details of your diagnosis from your urologist to include location and Gleason score for each positive biopsy sample, and get a diagram. The details are critical in determining which treatment options are open to you – the more advanced the cancer, the fewer the options. If for any reason you have doubts regarding the accuracy of the results or your doctor's interpretation of them, Or if you think he/she may not have used the most up-to-date diagnostic tools, get a second opinion. And if your urologist doesn't explain all the current treatments available and all their pros and cons, get a new urologist.
Each treatment option comes with a likely set of short and long term side effects and risks involving such things as incontinence and impotency, and with information on containment or spread, likelihood of recurrence, quality of life as you define it, and even long term survivability. Reliable data on survivability for a given treatment is a moving target. It takes upwards of 5-10 years to develop even as procedures and techniques continue to improve over time, making choices all the more difficult.
Given the uncertainties and variable results associated with different treatments, you need to establish up front just what your priorities are for treatment outcomes. And your spouse/significant other needs to be an integral part of the process. For example, she is more likely to be concerned with your health and survivability than your ability to perform sexually. Work through this together. You're a team.
When considering treatment options, consult with the specialists in their respective fields to gain first hand knowledge to help you make your decision and best achieve your priorities. Bear in mind, however, that each specialist tends to favor his particular procedure and is likely to recommend it as your best course of action. So ask a lot of questions, keep an open mind, and maintain a healthy level of skepticism.
Along with the diagnosed level of your cancer's aggressiveness, be sure to take into consideration your age and overall state of health. If your health is poor, you are diagnosed with early stage cancer, and you stand a good chance of dying from something other than the cancer, you may want to consider a less aggressive form of treatment such as watchful waiting involving more frequent PSA monitoring and substantial lifestyle changes to control the cancer's development.
To assist you in making a treatment choice you will be provided a copy of the class Treatment Selection Table which gives you the contact information, diagnoses and treatments selected by those classmates who have already been diagnosed with and treated for PC and have volunteered to assist newly diagnosed classmates on a one-on- one basis. Please keep this information confidential with regard to anyone not listed on the table. Also keep in mind that their circumstances and priorities for selecting a particular set of treatments may differ from yours. They will be happy to advise and assist, but should not attempt to impose their choices on you.
It may also be helpful for you to consult with any physicians you know, regardless of their specialty, and ask them what course of action they would take were they to be given a similar diagnosis. Their professional training and background will enable them to give you impartial, well reasoned recommendations, but bear in mind that the questions you pose are hypothetical and when confronted with a real diagnosis, their actual choices may differ.
Once you have decided on a particular treatment or combination of treatments, insure that the specialist you select to perform each procedure has extensive experience in performing it, has an excellent success rate and has a reputation to match, i.e. he/she performs many of them on a routine basis and is well regarded in the medical community. You do not need to participate in the development of anyone's learning curve. Check out his/her background – education and training, where he/she has practiced, years of experience, particular subspecialty. What do other professionals and prior patients have to say? Is he/she well equipped to deal with any preexisting health issues you might have or surprises he/she might encounter during the procedure? How much time and individual attention does he/she give you? What sort of vibes do you and your spouse get from the encounters? Are you comfortable with and confident in this individual's abilities? There is a helpful web site on choosing PC specialists at:
Each procedure comes with its own set of recovery problems, short and long term. Query the specialists in detail on these and do your own independent research. Don't become one of those "What the doctor didn't tell me." patients. To assist in asking all the right questions, The Prostate Cancer Foundation offers a free folder with inserts or you can download a .pdf copy at:
You will also be provided with a copy of our Prostate Cancer History Form for your personal use in maintaining a record of your diagnosis, treatment priorities, treatment selections and their progress. If in due course you decide to add your information to the Treatment Selection Table and make yourself available to assist other classmates, you can use this form as a basis for one-on-one consultations.
Finally, bear in mind that your diagnosis is a red flag that your lifestyle up to this point, together with the genes you inherited from your parents has not afforded you the protection necessary to avoid contracting the cancer, given whatever circumstances that may have led to the diagnosis. Although you had no control over your genetic inheritance, you can change your lifestyle. So the appropriate response to this diagnosis is not guilt, anger or self recrimination, but rather a firm commitment to make those lifestyle changes necessary to control and even defeat this cancer. To assist you in doing so, please refer to our Prostate Cancer Prevention and Control Guide on our web site at:
Print out a copy and give it to your spouse/significant other to beat you on and about the head with as necessary. You are now solidly in the control phase. Also, get your hands on a copy of Dean Ornish's book "The Spectrum." As discussed in the guide, it is an excellent complement to it. Another is the American Cancer Society's "Complete Guide to Nutrition for Cancer Survivors"